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PALS Interim Study Guide - PHS Institute

pals Study Guide 222000111666 Bulletin: New resuscitation science and American Heart Association treatment guidelines were released October 28, 2015! The new AHA Handbook of Emergency Cardiac Care (ECC) contains these 2016 Guidelines and is required Study for this course. The 2016 pals Provider Manual is not yet available. This Study Guide will provide you with additional Study information. Website: Keyword: pals15 (Pretest) ( Study info. For class for rhythm review) What is required to successfully complete pals ? C o m p l e t e d pals Pre-test is required for admission to the course. S c o r e 84% on the multiple-choice post-test. It is a timed test and you may be allowed to use your ECC Handbook. Y o u must be able to demonstrate: The pals rapid cardiopulmonary assessment Effective infant and child CPR using an AED on a child Safe defibrillation with a manual defibrillator maintaining an open airway Confirmation of effective ventilation addressing vascular access stating rhythm appropriate drugs, route and dose Consideration of treatable causes What happens if I do not do well in the course?

‹Apply the appropriate treatment algorithm: • Bradycardia with a PulseTachycardia with Adequate Perfusion • Tachycardia with Poor Perfusion

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Transcription of PALS Interim Study Guide - PHS Institute

1 pals Study Guide 222000111666 Bulletin: New resuscitation science and American Heart Association treatment guidelines were released October 28, 2015! The new AHA Handbook of Emergency Cardiac Care (ECC) contains these 2016 Guidelines and is required Study for this course. The 2016 pals Provider Manual is not yet available. This Study Guide will provide you with additional Study information. Website: Keyword: pals15 (Pretest) ( Study info. For class for rhythm review) What is required to successfully complete pals ? C o m p l e t e d pals Pre-test is required for admission to the course. S c o r e 84% on the multiple-choice post-test. It is a timed test and you may be allowed to use your ECC Handbook. Y o u must be able to demonstrate: The pals rapid cardiopulmonary assessment Effective infant and child CPR using an AED on a child Safe defibrillation with a manual defibrillator maintaining an open airway Confirmation of effective ventilation addressing vascular access stating rhythm appropriate drugs, route and dose Consideration of treatable causes What happens if I do not do well in the course?

2 The Course Director or Instructor will first remediate (tutor) you and you may be allowed to continue in the course. If it is decided you need more time to Study , you will be placed into the next course. Where do I start? CPR/AED: You will be tested with no coaching. If you cannot perform these skills well without coaching, you can/may be directed to take the course at another time. Know p. 7 of this Study Guide well. Arrhythmias: Before you come be sure you can identify: Sinus Rhythm (SR), Sinus Bradycardia (SB), Sinus tachycardia (ST), Supraventricular tachycardia (SVT), Ventricular tachycardia (VT), Ventricular Fibrillation (VF), Torsades de Pointes, Pulseless Electrical Activity (PEA) and Asystole. < 1 month < 60 1 month 1 year < 70 1 10 years < 70 + (2 x age in years) 10 + years < 90 5 Hs 5 Ts H ypoxia H ypo-volemia H ypo-thermia Hypo /hyper kalemia Hydro gen ion (acidosis) Hydro- Glycemia T amponade T ension pneumothorax T oxins poisons, drugs T hrombosis coronary (AMI) T hrombosis pulmonary (PE) T rauma You will need to know: * Respiratory Rate Heart Rate Age Rate Age Sleeping - Awake Infant 30 - 53 1- 12 months 90 - 205 Toddler 22 - 37 12 months - 2 years 90 - 180 Preschooler 20 - 28 2 5 years 80 - 140 School-age child Adolescent 18 - 25 12 - 20 5 - 10 years 10-15 years 58 - 118 50 - 100 ECC Handbook p.

3 77 * Hypotension by Systolic Blood Pressure (SBP) Age SBP Hypotension + signs of poor perfusion = Decompensated shock. ECC Handbook p. 77 * Treat Possible Causes . Spacing separations may help as a memory aid. Rapid Cardiopulmonary Assessment and Algorithms This is a systematic head-to-toe assessment used to identify infants and children in respiratory distress and failure, shock and pulseless arrest. Algorithms are menus that Guide you through recommended treatment interventions. Know the following assessment because it begins all pals case scenarios. The information you gather during the assessment will determine which algorithm you choose for the patient s treatment. After each intervention you will reassess the patient again using the head-to-toe assessment. Start with child s general appearance: Is the level of consciousness: A= awake V= responds to verbal P= responds to pain U= unresponsive Is the overall color: good or bad?

4 Is the muscle tone: good or floppy? Then assess CABs: (stop and give immediate support when needed, then continue with assessment) Circulation: Is central pulse present or absent? Is the rate normal or too slow or too fast? Is the rhythm regular or irregular? Is the QRS narrow or wide? Airway: Open and hold with head tilt-chin lift Breathing: Is it present or absent? Is the rate normal or too slow or too fast? Is the pattern regular or irregular or gasping? Is the depth normal or shallow or deep? Is there nasal flaring or sternal retractions or accessory muscle use? Is there stridor or grunting or wheezing? Next look at perfusion: Is the central pulse versus peripheral pulse strength equal or unequal? Is skin color, pattern and temperature normal or abnormal? Is capillary refill normal or abnormal (greater than 2 seconds)?

5 Is the liver edge palpated at the costal margin (normal or dry) or below the costal margin (fluid overload)? And check: Is systolic BP acceptable for age (normal or compensated) or hypotensive? Is urine output adequate for: infants and children (1 2cc/kg/hr) or adolescents (30cc/hr)? Now classify the physiologic status: Stable: needs little support; reassess frequently Unstable: needs immediate support and intervention Respiratory distress: increased rate, effort and noise of breathing; requires much energy Respiratory failure: slow or absent rate, weak or no effort and is very quiet Compensated shock: SBP is acceptable but perfusion is poor: central vs. peripheral pulse strength is unequal peripheral color is poor and skin is cool capillary refill is prolonged Decompensated shock: Systolic hypotension with poor or absent pulses, poor color, weak compensatory effort.

6 Apply the appropriate treatment algorithm : Bradycardia with a pulse tachycardia with Adequate Perfusion tachycardia with Poor Perfusion Pulseless Arrest: VF/VT and Asystole/PEA Advanced Airway A cuffed or uncuffed Endotracheal Tube (ET) may be used on Infants and children. To estimate tube size: ECC Handbook p. 94 Uncuffed = (Age in years 4) + 4 Example: (4 years 4) = 1 + 4 = 5 Cuffed = (Age in years 4) + Example: (4 years 4) = 1 + = Depth = (Age in years 2) + 12 Example: (4 years 2) = 2 + 12 = 14 Immediately confirm tube placement by clinical assessment and a device: Clinical assessment: Look for bilateral chest rise. Listen for breath sounds over stomach and the 4 lung fields (left and right anterior and midaxillary). Look for water vapor in the tube (if seen this is helpful but not definitive).

7 Devices: End-Tidal CO2 Detector (ETD): if weight > 2 kg Attaches between the ET and Ambu bag; give 6 breaths with the Ambu bag: - Litmus paper center should change color with each inhalation and each exhalation. - Original color on inhalation = - Color change on exhalation = Okay CO2!! O2 is being inhaled: expected. Tube is in trachea. - Original color on exhalation = Oh-OH!! Litmus paper is wet: replace ETD. Tube is not in trachea: remove ET. Cardiac output is low during CPR. Esophageal Detector (EDD): if weight > 20 kg and in a perfusing rhythm * Resembles a turkey baster: - Compress the bulb and attach to end of ET. - Bulb inflates quickly! Tube is in the trachea. - Bulb inflates poorly? Tube is in the esophagus. * No recommendation for its use in cardiac arrest. When sudden deterioration of an intubated patient occurs, immediately check: Displaced = tube is not in trachea or has moved into a bronchus (right main stem most common) Obstruction = consider secretions or kinking of the tube Pneumothorax = consider chest trauma or barotraumas or non-compliant lung disease Equipment = check oxygen source and Ambu bag and ventilator pals Drugs In Arrest: Epinephrine: catecholamine ECC Handbook p.

8 92 Increases heart rate, peripheral vascular resistance and cardiac output; during CPR increases myocardial and cerebral blood flow. IV/IO: mg/kg of 1:10 000 solution (equals mL/kg of the 1:10 000 solution); repeat q. 3 5 min ET: mg/kg of 1:1000 solution (equals mL/kg of the 1:1000 solution); repeat q. 3 5 min Anti-arrhythmic Drugs: Amiodarone: atrial and ventricular antiarrhythmic ECC Handbook p. 89 Slows AV nodal and ventricular conduction, increases the QT interval and may cause vasodilation. Refractory VF/PVT: IV/IO: 5 mg/kg bolus (may repeat up to 2 times) Perfusing VT: IV/IO: 5 mg/kg over 20-60 min Perfusing SVT: IV/IO: 5 mg/kg over 20-60 min Max: 15 mg/kg per 24 hours Max single dose 300mg Caution: hypotension, Torsade; half-life is up to 40 days Lidocaine: ventricular antiarrhythmic to consider when amiodarone is unavailable ECC Handbook p.

9 94 Decreases ventricular automaticity, conduction and repolarization. VF/PVT: IV/IO: 1 mg/kg bolus repeat >15 min ET: 2 -3 mg/kg Perfusing VT: IV/IO: 1 mg/kg bolus repeat >15 min Infusion: 20-50 mcg/kg/min Caution: neuro toxicity seizures Magnesium: ventricular antiarrhythmic for Torsade and hypomagnesemia ECC Handbook p. 94 Shortens ventricular depolarization and repolarization (decreases the QT interval). IV/IO: 25-50 mg/kg over 10 20 min; give faster in Torsade Max: 2 gm Caution: hypotension, bradycardia Procainamide: atrial and ventricular antiarrhythmic to consider for perfusing rhythms ECC Handbook p. 96 Slows conduction speed and prolongs ventricular de- and repolarization (increases the QT interval). Perfusing recurrent VT: IV/IO: 15 mg/kg infused over 30 60 min Recurrent SVT: IV/IO: 15 mg/kg infused over 30 60 min Caution: hypotension; use it with extreme caution with amiodarone as it can cause AV block or Torsade Increase heart rate: Epinephrine: drug of choice for pediatric bradycardia after oxygen and ventilation ECC Handbook p.

10 80 Increases heart rate, peripheral vascular resistance and cardiac output; during CPR increases myocardial and cerebral blood flow. IV/IO: mg/kg of 1:10 000 solution (equals mL/kg of the 1:10 000 solution); repeat q. 3 5 min ET: mg/kg of 1:1000 solution (equals mL/kg of the 1:1000 solution); repeat q. 3 5 min Atropine: vagolytic to consider after oxygen, ventilation and epinephrine ECC Handbook p. 87 Blocks vagal input therefore increases SA node activity and improves AV conduction. IV/IO: mg/kg; (max dose ) Caution: do not give less than mg or may worsen the bradycardia 2010 (New): Atropine is not recommended for routine use in the management of PEA/asystole and has been removed from the pals Cardiac Arrest algorithm . The treatment of PEA/asystole is now consistent in the PALSD ecrease heart rate: Adenosine: drug of choice for symptomatic SVT & Wide Complex Monomorphic VT See ECC Handbook p.


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